75 - Does Normothermia in the Delivery Room Predict NICU Admission Normothermia?

Poster Number: 75
Publication Number: 75.437

Gelila M. Asefa, Cohen Children's Medical Center, Glen Oaks, NY, United States; Danielle D’Alleva-Byrne, Cohen Children's Medical Center, Kings Park, NY, United States; Melissa Duran, Northwell Health, Queens, NY, United States; Kamesha K. Bailey, Division of Neonatal-Perinatal Medicine, Cohen Children’s Medical Center, Northwell Health and Zucker School of Medicine at Hofstra/Northwell, Floral Park, NY, United States; Mary O'Connell, Northwell Health, Little Neck, NY, United States; Joanna Fishbein, Northwell Health, Plainview, NY, United States; Barry Weinberger, Division of Neonatal-Perinatal Medicine, Cohen Children’s Medical Center, Northwell Health and Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, United States; Vita Boyar, Division of Neonatal-Perinatal Medicine, Cohen Children’s Medical Center, Northwell Health and Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, United States

Background: Normothermia during the first hour of life improves neonatal outcomes.  WHO, AAP, ACOG, and ILCOR recommend that the temperature of newborns be maintained at > 36.5°C. Practice bundles to prevent hypothermia during the “golden hour” have become the standard of care, including warming mattresses, bags, and thermal hats. Temperature is routinely assessed on admission to NICU, but the optimal time and method of assessing temperature after birth is not known.

Objective: Our objective was to determine whether standard early diagnosis and treatment of hypothermia in the Delivery Room/Operating Room (DR/OR) decreases NICU admission hypothermia.  We hypothesize that 1) infant’s post-stabilization temperature in the delivery room is an accurate predictor of NICU admission temperature, and 2) axillary temperatures agree with rectal measurements.

Design/Methods: Newborn axillary temperatures were obtained in the DR/OR (a 2–3-minute walk from the NICU) from March 2020-September 2021.  Medical teams were instructed to perform standard interventions based on the unit’s “hypothermia prevention bundle” and to achieve and document normothermia before departure from the DR/OR if possible.  Temperatures were then also obtained by both axillary and rectal measurements on admission to the NICU within 1 hour of birth (n=445, including 331 with DR/OR measurements).  

Results: DR/OR axillary temperature moderately correlated with NICU admission temperature (Pearson coefficient 0.40, p < .0001). After adjusting for delivery mode, respiratory support, gestational age, and time between measurements, DR/OR axillary temperature remained significantly associated with NICU admission temperature (p < 0.0001).  Axillary temperatures were, on average, 0.13 ± 0.35°C lower than rectal measurements (Bland Altman limits of agreement -0.57 to 0.83) (Fig. 1).    Conclusion(s): Our findings suggest that achievement of normothermia in the DR/OR immediately after initial resuscitation is feasible and may decrease NICU admission hypothermia and its sequelae. Quality improvement interventions to decrease NICU hypothermia should include practices to decrease or eliminate DR/OR hypothermia.  Axillary temperatures are a good approximation of rectal temperatures, enabling repeated non-invasive measurements to facilitate normothermia in the DR/OR and on admission to NICU.   
Bland Altman plot of rectal and axillary temperatures on admission to the NICUThe solid red line represents the mean difference between rectal and axillary temperatures. The dashed red lines represent the lower and upper limits of the interval of agreement. The mean difference is 0.13 C (limits of agreement -0.57 and 0.83), indicating that 95% of the differences between the two measurements are within this range.